Editorials

Compulsory screening of immigrants for tuberculosis and HIV

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7435.298 (Published 05 February 2004) Cite this as: BMJ 2004;328:298
  1. Richard Coker, senior lecturer (richard.coker@lshtm.ac.uk)
  1. European Centre on Health of Societies in Transition (ECOHOST), Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT

    Is not based on adequate evidence, and has practical and ethical problems

    Increased movements of peoples are stressing public health responses to threats from communicable diseases internationally. This year several bodies in the United Kingdom, including the Conservative party, have called for compulsory screening of immigrant populations for tuberculosis and HIV in order to support national efforts to control these communicable diseases. Given that concerns about asylum policy are consistently high on the political agenda, and that the media have recently taken to conflating anti-immigrant sentiments with public health threats through communicable diseases,1 the government may be considering compulsory screening of immigrants for some infectious diseases. But is there a rational public health argument that is grounded in evidence for compulsory screening of immigrants?

    For tuberculosis and HIV the purpose of screening should be twofold—to identify cases early such that individuals can be offered treatment and care, and so to inhibit further transmission (through treatment, behaviour change, or isolation) to protect public health.

    For tuberculosis the notion that screening immigrants detects those with the disease and therefore benefits public health is not straightforward. Although the increase in rates of tuberculosis in England and Wales over the past decade is clearly associated with immigrants, this does not translate into a cogent argument in favour of screening immigrants, never mind compulsory screening.2

    Most active tubercular disease seems to develop after immigration.3 Clearly, those individuals in whom tuberculosis is identified early can benefit from treatment, but little evidence exists to show that early detection of tuberculosis in foreign born individuals conveys appreciable public health …

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